Objective. Hyperthyroidism has been described as elevated serum free T3 and/or
free T4 levels with decreased thyrotropin (TSH) concentrations. The main causes are related to
autoimmune and neoplastic pathology. However, it might be caused due to a long-term topical
exposure (iodine solution dressing) or by intravenous administration of
iodine-containing substances.
Both clinical and laboratory features might be presented. The
main management is based on interruption of all exposures with
iodine solutions and also antithyroid medicine in case of severe
laboratory and clinical disturbances.
Data Sources.
We present a case of iodine-induced hyperthyroidism
in a critically ill ICU patient caused by excessive iodine
containing antiseptic solution washes and contrast agent administration.
The patient was successfully treated by discontinuing iodine exposure and
beta-blocker administration.
Conclusions.
In patients with underlying thyroid gland pathology, thyroid-function
tests and clinical observation in the ICU are of critical importance.
Non-missile transorbital penetrating head injuries are relatively rare, though potentially fatal injuries. Trajectory for intracranial entrance is typically via the orbital roof, the superior orbital fissure (SOF), or the optic canal. Non-metallic intracranial penetrating injuries are even scarcer and may pose unusual diagnostic and surgical challenges. Here we present and discuss a unique case of a penetrating injury by a wooden foreign body (FB) which entered and expanded the inter-dural space of the lateral cavernous sinus (CS) sinus wall without intracavernous or intradural involvement. The patient was a 71 year-old male who fell face-down and sustained a penetrating transorbital injury by a dry twig fragment, which passed through the SOF and into the interdural space of lateral wall of the ipsilateral CS. The patient was fully conscious (GCS15) at presentation but had severe ocular injury (complete ophthalmoplegia and blindness of the injured eye). The wooden FB was successfully removed via a minimally invasive subtemporal intradural approach with no apparent immediate or long-term complications. We emphasize the unusual diagnostic and surgical challenges related to this kind of rare injuries as reflected by the decision-making considerations taken in the presented case.
Page kidney is a well-known phenomenon causing hypertension, due to compression of renal parenchyma by a subcapsular hematoma, of either traumatic or non-traumatic origin. The main therapeutic approach is based on surgical approach (nephrectomy or hematoma evacuation) and antihypertensive treatment. In this paper we present a post-traumatic case of Page Kidney in a Critical Care unit. We discuss different therapeutical opportunities to extremely elevated systemic blood pressure resistant to traditional drug therapy.
ObjectivePericardiocentesis is a well-known procedure commonly performed by either image-guided intervention or surgical approaches. Computed tomography (CT)–guided pericardiocentesis is not widely used, but provides certain advantages. In the article we will discuss our technique of CT-guided therapeutic pericardiocentesis, including advantages and disadvantages, patient selection, possible approaches, and complications.MethodsThe retrospective study included 121 therapeutic pericardial drainages performed under CT guidance. Demographic data of the patients, entry site, and needle orientation were recorded. Procedure complications and their significance were analyzed.ResultsOne hundred and twenty-one pericardial drainages with catheter insertion were performed under CT guidance on 119 patients presenting with clinically significant pericardial effusion. The most common approach was at the left anterior chest wall. The rate of minor complications was 5.8%, no major complications occurred.ConclusionsTherapeutic pericardiocentesis can be obtained under CT guidance in a safe and effective manner. Recommendations for building a patient-centered protocol with an interdisciplinary team are discussed. Patient selection, procedural guidance, and lessons to avoid complications are reviewed.
Enteral nutrition is crucial for ensuring that critically ill patients have a proper intake of food, water, and medicine. Methods to ensure this requirement should be initiated as early as possible. The use of PPF has several advantages compared to the use of a nasogastric feeding tube. In the present paper, the cases of three critically ill patients with a nonfunctional gastrointestinal system on admission to ICU, are detailed. Enteral feeding through a nasogastric tube by prokinetic agent therapy had been unsuccessful. The bedside placement of a post-pyloric feeding tube by the DRX-Revolution X-ray system is described.
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